Provider Demographics
NPI:1679026033
Name:JOHNSON, DAVID B (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4401 EGAN DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2024
Mailing Address - Country:US
Mailing Address - Phone:952-746-4162
Mailing Address - Fax:952-808-3112
Practice Address - Street 1:6600 FRANCE AVE S STE 206
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1810
Practice Address - Country:US
Practice Address - Phone:952-926-7515
Practice Address - Fax:952-952-8155
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400350746Medicare PIN